Midlevel Provider

Midlevel Dental Professionals

An Act to Improve Oral Health for All Massachusetts Residents would create a new class of midlevel dental professionals, while mandating commonsense requirements that protect patient safety and providing additional resources aimed at increasing access to care for underserved populations.

The Issue

The Massachusetts Dental Society believes that a comprehensive approach is needed to address oral health care issues facing the Commonwealth.

According to the 2017 Massachusetts State Health Assessment“There are notable racial/ethnic disparities in oral health care utilization for children, adults, and pregnant women. Insurance status is often a barrier to accessing oral health care, along with lack of adequate transportation to attend an appointment. Improving access to oral health services and preventive measures, such as community water fluoridation, is important to preventing and treating oral diseases.” 

The introduction of a new class of midlevel dental professionals is one strategy for increasing access to care in underserved areas. While multiple bills were filed in the 2017-2018 legislative session concerning midlevel providers, An Act to Improve Oral Health for All Massachusetts Residents was introduced in April 2018 as consensus legislation following an agreement by leaders of the House of Representatives and Senate, as well as key advocates and stakeholders.


Legislative Solution

An Act to Improve Oral Health for All Massachusetts Residents focuses on providing care for underserved populations and reducing socioeconomic barriers to seeking dental care. This comprehensive approach to improving oral health would create a new class of midlevel providers called dental therapists, while enacting commonsense requirements to protect patient safety. It also calls for oral health education for community health workers, education and assistance for local and regional boards of health related to community water fluoridation, and information for parents on children’s oral health screenings.

Key provisions of the legislation include:

Dental Therapists

As a condition of licensure, dental therapists must:
  • Obtain a bachelor’s and master’s degree
  • Pass a comprehensive, competency-based clinical examination approved by the Commission on Dental Accreditation (CODA)

Dental therapists must work under the direct supervision of a licensed dentist for the first two years or 2,500 hours of practice, whichever is longer. After that time, dental therapists are authorized to perform under general supervision:

  • All procedures and services within the scope of a public health dental hygienist
  • All procedures and services listed in the CODA dental therapy standards

Advanced procedures—such as preparation and placement of direct restorations in primary and permanent teeth, preparation and placement of preformed crowns on primary teeth, and simple extractions of erupted primary teeth—must be performed under direct supervision. The supervising dentist can further limit the scope.

To ensure proper supervision, a supervising dentist is limited to having a collaborative management agreement with no more than three (3) dental therapists at the same time.

If practicing outside of a federally qualified health center, dental therapists must maintain a caseload of at least 50% of patients who receive coverage through MassHealth or are considered underserved.

Community Health Workers

As a condition for certification or renewal of certification, community health workers must receive education and or training in oral health.

Community Water Fluoridation

To increase awareness of the health benefits of fluoridated water in public drinking supplies, local and regional boards of health must be provided information, education, technical assistance, and seminars regarding water fluoridation as requested by municipalities and other local and regional governmental entities. 

Children's Oral Health Screenings

Additionally, all public schools shall notify parents or legal guardians concerning the importance of oral health screenings, including information on programs and services to access affordable dental care.

Historical Overview

MDS Legislation

The Massachusetts Dental Society (MDS) believes the issue of midlevel professionals is just one aspect of public health considerations surrounding oral health care. That’s why the MDS introduced legislation in January 2017 that not only addressed existing proposals aimed at creating midlevel dental professionals, but also problems facing underserved populations, especially children, who do not receive oral health care, including preventive treatments.

In the 2017-2018 legislative session, the Massachusetts State Legislature’s Joint Committee on Public Health was referred multiple bills seeking to authorize a midlevel oral health provider. The MDS advocated for An Act Relative to Graduate Education for Certain Professionals, legislation to create a public health dental practitioner position as part of a multi-faceted, comprehensive plan for improving access to oral health care. Under the MDS-backed legislation, this new practitioner would be directly supervised by a dentist and limited to providing care in designated dental shortage areas or at federally designated health centers, following two years of post-baccalaureate education. This new class of providers also would be required to meet educational standards comparable to similar practitioners in primary care, such as nurse practitioners and physician assistants.

An Act Relative to Graduate Education for Certain Professionals offered a comprehensive approach to improved access and oral health care for underserved populations, including:

  • Increased advocacy for and awareness of fluoridated water in Massachusetts communities
  • Improved integration of dental hygiene into the state’s Department of Public Health
  • Mandatory dental screenings of children prior to entering kindergarten
  • Introduction of a new class of "midlevel" dental practitioners

Legislative Agreement

Through the introduction of legislation, the MDS had the opportunity to work with leadership of the state’s House of Representatives and Senate, as well as key advocates and stakeholders, to reach an agreement on legislation that would best serve Massachusetts and serve as a model for the rest of the country.

In April 2018 a legislative agreement was reached with leadership of the state’s House of Representatives and Senate, as well as key advocates and stakeholders, on new bill language that would create a new class of dental therapist professionals. Under the terms of the agreement, the MDS succeeded in securing commonsense requirements that protect patient safety by ensuring master’s level training of licensed therapists, supervision by licensed dentists, and additional resources aimed at increasing access to care for underserved populations. The new legislation was introduced as An Act to Improve Oral Health for All Massachusetts Residents.

The Legislature concluded its formal session on July 31, 2018, before the comprehensive oral health legislation moved through the entire legislative process. The legislation was re-introduced when a new session convened in January 2019.

Media

PRESS RELEASES


IN THE NEWS


MDS BOSTON GLOBE AD

As part of its media engagement on the issue of midlevel dental professionals, the MDS placed an ad in the September 17, 2017, print edition of the Sunday Boston Globe. The ad is a message to Massachusetts residents about the importance of requiring the highest level of education, training, and supervision of a new class of midlevel dental providers and our commitment as dentists to fight for safe, effective, and accessible care for all residents of the Commonwealth.

 

Boston Herald Radio_Lustbader_264_180

MDS PRESIDENT TALKS MIDLEVEL LEGISLATION ON BOSTON HERALD RADIO

On October 18, 2017, then-President Dr. David Lustbader was a guest on the Boston Herald Radio Morning Meeting show. He spoke on the MDS’s comprehensive oral health legislation (S.142/H.2820) and the critical importance of requiring proper training, credentialing, and supervision of a new class of midlevel dental providers in Massachusetts.
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